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Alphabetical Listing by Therapeutic Category GOODFELLOW AFB ROSS CLINIC FORMULARY

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Alphabetical Listing by Therapeutic Category GOODFELLOW AFB ROSS CLINIC FORMULARY GOODFELLOW AFB ROSS CLINIC FORMULARY Alphabetical Listing by Therapeutic Category This document is current as of October 8, 2020. The availability of formulary items is subject to change. ACARBOSE Acarbose ALPRAZolam Outpatient Dosage Forms Outpatient Formulary Brands Available Xanax Tablet, Oral: Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg Tablet, Oral: Xanax: 0.5 mg, 1 mg [scored] Acetaminophen Generic: 0.5 mg, 1 mg Outpatient Formulary Brands Available Mapap Children's [OTC]; Mapap [OTC] Aluminum Chloride Hexahydrate Outpatient Dosage Forms Outpatient Formulary Brands Available Drysol Suspension, Oral: Outpatient Dosage Forms Mapap Children's: 160 mg/5 mL (118 mL) [ethanol free; contains propylene Solution, External: glycol, sodium benzoate; cherry flavor] Drysol: 20% (60 mL) Tablet, Oral: Mapap: 325 mg Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone Generic: 325 mg Outpatient Dosage Forms Liquid, Oral: Acetaminophen and Codeine Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and Outpatient Dosage Forms simethicone 20 mg per 5 mL (360 mL) Solution, Oral [C-V]: Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL Amantadine (118 mL) [BCF] Outpatient Dosage Forms Tablet, Oral [C-III]: Capsule, Oral, as hydrochloride: Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Generic: 100 mg [BCF] AcetaZOLAMIDE Amiodarone Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 250 mg Generic: 200 mg [BCF] Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone Amitriptyline Outpatient Dosage Forms Outpatient Dosage Forms Solution, Otic: Tablet, Oral, as hydrochloride: Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone Generic: 10 mg [BCF], 25 mg [BCF], 75 mg [BCF] 1% (10 mL) AmLODIPine Acyclovir (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Capsule, Oral: Generic: 200 mg [BCF] Amlodipine and Benazepril Tablet, Oral: Outpatient Formulary Brands Available Lotrel Generic: 800 mg [BCF] Outpatient Dosage Forms Acyclovir (Topical) Capsule, Oral: Lotrel: Outpatient Formulary Brands Available Zovirax 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Outpatient Dosage Forms 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Cream, External: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Zovirax: 5% (5 g) 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Generic: 5% (5 g) 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Ointment, External: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Zovirax: 5% (30 g) Generic: Generic: 5% (30 g) 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Albendazole 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Outpatient Formulary Brands Available Albenza 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Outpatient Dosage Forms 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Tablet, Oral: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF Albenza: 200 mg [contains saccharin sodium] Generic: 200 mg Amoxicillin Albuterol Outpatient Dosage Forms Capsule, Oral: Outpatient Formulary Brands Available Proventil® HFA Generic: 250 mg [BCF], 500 mg [BCF] Outpatient Dosage Forms Suspension Reconstituted, Oral: Aerosol Solution, Inhalation: Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (150 mL) [BCF]; 400 mg/5 mL ProAir HFA: 90 mcg/actuation (8.5 g) (100 mL) [BCF] Generic: 90 mcg/actuation (8.5 g) Tablet, Oral: Nebulization Solution, Inhalation: Generic: 875 mg Generic: 0.083% [2.5 mg/3 mL] (60s) [BCF] Nebulization Solution, Inhalation [preservative free]: Amoxicillin and Clavulanate Generic: 0.083% [2.5 mg/3 mL] (60s) [BCF] Outpatient Dosage Forms Suspension Reconstituted, Oral: Alendronate Generic: Outpatient Formulary Brands Available Fosamax 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (100 Outpatient Dosage Forms mL) [BCF] Tablet, Oral: 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (100 Fosamax: 35 mg [BCF], 70 mg [BCF] mL) [BCF] Generic: 35 mg [BCF], 70 mg [BCF] 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (125 mL) [BCF] Alfuzosin Tablet, Oral: Outpatient Formulary Brands Available Uroxatral Generic: Outpatient Dosage Forms 500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF] Tablet Extended Release 24 Hour, Oral, as hydrochloride: 875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF] Uroxatral: 10 mg [BCF] Tablet Extended Release 12 Hour, Oral: Generic: 10 mg [BCF] Generic: Amoxicillin 1000 mg and clavulanate acid 62.5 mg Allopurinol Anastrozole Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 100 mg [BCF], 300 mg [BCF] Generic: 1 mg 2 CALCITRIOL (SYSTEMIC) Apixaban Outpatient Dosage Forms Outpatient Formulary Brands Available Eliquis Lozenge, Mouth/Throat: Outpatient Dosage Forms Cepacol Sore Throat: 15 mg (16 ea) [contains cetylpyridinium, menthol; cherry Tablet, Oral: flavor] Eliquis: 5 mg Benzonatate ARIPiprazole Outpatient Formulary Brands Available Tessalon Perles Outpatient Formulary Brands Available Abilify Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Tablet, Oral: Tessalon Perles: 100 mg Abilify: 2 mg, 5 mg, 10 mg Generic: 100 mg Generic: 2 mg, 5 mg, 10 mg Benzoyl Peroxide Artificial Tears Outpatient Dosage Forms Outpatient Dosage Forms Gel, External: Ointment, Ophthalmic: Generic: 2.5% (60 g), 10% (45 g) Refresh P.M.: 3.5 g Solution, Ophthalmic: Liquid, External [wash]: Generic: Polyvinyl alcohol 1.4% (15 mL, 30 mL) Generic: 5% (148 g); 10% (148 g) Aspirin Benztropine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Chewable, Oral: Tablet, Oral, as mesylate: Generic: 81 mg Generic: 1 mg [BCF] Tablet, Enteric Coated, Oral: Generic: 81 mg, 325 mg Betamethasone and Clotrimazole Outpatient Dosage Forms Atenolol Cream, External: Outpatient Dosage Forms Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole Tablet, Oral: 1% (15 g) Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Bisacodyl AtoMOXetine Outpatient Formulary Brands Available Ducodyl [OTC] Outpatient Formulary Brands Available Strattera Outpatient Dosage Forms Outpatient Dosage Forms Suppository, Rectal: Capsule, Oral: Generic: 10 mg (12 ea, 50 ea, 100 ea) Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg Generic: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg Tablet Delayed Release, Oral: Ducodyl: 5 mg AtorvaSTATin Outpatient Formulary Brands Available Lipitor Bismuth Subsalicylate Outpatient Dosage Forms Outpatient Formulary Brands Available Peptic Relief [OTC] Tablet, Oral: Outpatient Dosage Forms Lipitor: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Tablet Chewable, Oral, as subsalicylate: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Peptic Relief: 262 mg Generic: 262 mg Atovaquone and Proguanil Outpatient Formulary Brands Available Malarone Brimonidine (Ophthalmic) Outpatient Dosage Forms Outpatient Formulary Brands Available Alphagan P Tablet, Oral: Outpatient Dosage Forms Malarone: Atovaquone 250 mg and proguanil hydrochloride 100 mg Solution, Ophthalmic, as tartrate: Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg Alphagan P: 0.1% (10 mL); 0.15% (5 mL) [contains Purite] Atropine (Ophthalmic) Generic: 0.15% (5 mL) [BCF]; 0.2% (5 mL) [BCF] Outpatient Dosage Forms Budesonide (Oral Inhalation) Solution, Ophthalmic, as sulfate [drops]: Outpatient Dosage Forms Generic: 1% (15 mL) Suspension, Inhalation: Azelastine (Nasal) Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL) Outpatient Dosage Forms BuPROPion Solution, Nasal, as hydrochloride: Generic: 0.1% [137 mcg/spray] (30 mL) Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Azithromycin (Systemic) Generic: 75 mg [BCF] Outpatient Formulary Brands Available Zithromax Tablet Extended Release 12 Hour, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 100 mg [BCF] Packet, Oral: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Zithromax: 1 g (3 ea) [cherry-banana flavor] [BCF] Generic: 300 mg [BCF] Generic: 1 g (3 ea) [BCF] Suspension Reconstituted, Oral: BusPIRone Zithromax: 100 mg/5 mL (15 mL) [cherry-vanilla-banana flavor] [BCF] Outpatient Dosage Forms Zithromax: 200 mg/5 mL (15 mL) [cherry flavor] Tablet, Oral, as hydrochloride: Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL) Generic: 5 mg [BCF], 15 mg [BCF] Tablet, Oral: Generic: 500 mg [BCF] Butalbital, Acetaminophen, and Caffeine Bacitracin and Polymyxin B (Ophthalmic) Outpatient Dosage Forms Tablet, Oral: Outpatient Dosage Forms Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF] Ointment, Ophthalmic: Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g) Calcipotriene Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) Outpatient Dosage Forms Outpatient Dosage Forms Ointment, External: Ointment, Ophthalmic: Generic: 0.005% (60 g) Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units Calcitriol (Systemic) per g (3.5 g) [BCF] Outpatient Dosage Forms Benzocaine Capsule, Oral: Outpatient Formulary Brands Available Cepacol Sore Throat [OTC] Generic: 0.25 mcg 3 CALCIUM AND VITAMIN D Calcium and Vitamin D Ciclopirox Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, External: Generic: Calcium 500 mg and vitamin D 200 units; Calcium
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